Management algorithm of external fixation in lower leg arterial injury for limb salvages.

PURPOSE: The aim of this study is to investigate the outcome of these limb-threatening injuries through external fixation treatment and to discuss the case of patients' functional recovery after external fixation. METHODS: Demographics, surgical treatment and outcomes in 88 patients with lower leg arterial injuries treated by external fixation at two trauma centers from 2009 to 2018 were reviewed. The primary outcome was the rate of successful lower leg salvage, while secondary outcomes were complications and functional recovery. RESULTS: Eighty-eight patients were identified and 80 patients (90 legs) maintained a successful lower leg salvage. The mean age was 32.7 ± 10.8 years, and 81.8% were male. The primary outcomes included the following complications: pin-tract infection (8 legs), pins loosening (4 pins), wound superficial infection (7 legs), deep infection developed osteomyelitis (3 legs), bone nonunion or bone defect (17 legs) and amputation (8 legs). The average healing time of fracture was 5.6 ± 4.3 months. The maintain of external fixation average time was 5.8 ± 3.6 months. The improvement of scores of the pain, function and quality of life in our follow-up was statistically significant. CONCLUSION: For the lower extremity fracture patients with vascular injuries, using external fixation correctly can improve clinical outcomes and produce the improvement of pain, function and the quality of life. LEVEL OF EVIDENCE: Retrospective cohort, level IV.

The prevalence and risk factors of dislocation after primary total hip arthroplasty.

This study aimed to investigate the occurrence of dislocation and risk factors following primary total hip arthroplasty (THA). Retrospective analysis was done on the clinical data of 441patients with primary total hip arthroplasty who were admitted to our hospital between May 2018 and early December 2020. A total of 294 patients without posterior soft tissue repair were included as control group, and a total of 147 patients with repair of the short external rotator muscle and joint capsule were assigned to the repair group. All operated patients were observed to analyze the occurrence and risk of early postoperative dislocation. Within 6 months after hip arthroplasty, the early hip dislocation rate in the repair group was 0.68%, which was significantly lower than that in the control group (4.78%) (P < 0.05). The results of multifactorial analysis showed that age ≥75 years, combined limb or mental illness, artificial femoral head diameter <30 mm, posterolateral approach and prosthesis placement outside the safety zone, and improper handling were risk factors for dislocation (P < 0.05); The incidence of re-dislocation was lower in the targeted intervention group (P < 0.05). The occurrence of dislocation after THA is related to age, gender, and type of orthopedic disease. The risk factors should be explored to develop targeted intervention protocol, decreasing the dislocation rate and improving the prognosis.

MicroRNA-124-3p inhibits the differentiation of precartilaginous stem cells into nucleus pulposus-like cells via targeting FSTL1.

MicroRNA (miRNA/miR)-124-3p has been extensively studied in tumor biology and stem cells. However, little is known regarding its functional roles in the differentiation of precartilaginous stem cells (PSCs) into nucleus pulposus-like cells (NPLCs). In the present study, using miRNA microarray screening, it was demonstrated that the miRNA expression profiles differed between rat primary PSCs and TGF-ß1-induced differentiated NPLCs, and that miR-124-3p was significantly differentially expressed during the differentiation of PSCs to NPLCs. Furthermore, RT-qPCR analysis verified that miR-124-3p expression was decreased during PSC differentiation, with the lowest levels being detected at the later stages. Subsequent experiments revealed that miR-124-3p overexpression significantly decreased the expression of the extracellular matrix proteins, aggrecan and collagen type II, which was accompanied by a significant decrease in follistatin-related protein 1 (FSTL1) expression levels. Moreover, bioinformatics analysis indicated that FSTL1 was a potential target of miR-124-3p, which was additionally verified using luciferase reporter assays. Taken together, these data revealed a specific regulatory pathway of miR-124-3p, which negatively regulated its target gene, FSTL1, during the differentiation of PSCs to NPLCs, and suggested a functional role for miR-124-3p in the differentiation of PSCs.

The role and clinical significance of long noncoding RNA zinc finger E-box-binding homeobox two antisense RNA 1 in promoting osteosarcoma cancer cell proliferation, inhibiting apoptosis and increasing migration by regulating miR-145.

We aimed to investigate the expression level of long noncoding RNA (lncRNA) zinc finger E-box-binding homeobox two antisense RNA 1 (ZEB2-AS1) in osteosarcoma and explore its possible regulatory mechanisms. Expression of lncRNA ZEB2-AS1 was detected by quantitative real-time PCR in 63 cancerous tissues and 25 adjacent normal mucosal tissues from patients with osteosarcoma. The correlation between the lncRNA ZEB2-AS1 level and clinicopathological characteristics of the osteosarcoma patients were evaluated, and 5-year overall survival (5OS) was also analyzed according to lncRNA ZEB2-AS1 expression. The ZEB2-AS1 and miR-145 recombinant expression vector was used to analyze their relationship in an in vitro cell system. Luciferase reporter gene assays and RNA immunoprecipitation assays were used to verify the interaction between ZEB2-AS1 and miR-145. The proliferation, apoptosis and migration of osteosarcoma cells were determined by Cell counting kit-8 assays, Annexin V-PI assays and transwell assays, respectively. A significantly increased level of lncRNA ZEB2-AS1 with a fold change of 3.86 was found in osteosarcoma tissues compared with control tissues (P < 0.001). The Chi-square test revealed that lncRNA ZEB2-AS1 expression in osteosarcoma was significantly different according to radiology classification (P = 0.018), TNM stage (P = 0.000) and survival status (P = 0.005). The 5OS was 18.4% and 52% in osteosarcoma patients with higher and lower lncRNA ZEB2-AS1 expression, respectively. Significantly increased ZEB2-AS1 expression was found in osteosarcoma cells, while decreased levels of miR-145 were confirmed in osteosarcoma tissues and cell lines compared to controls. Moreover, a negative correlation was found between the expression level of ZEB2-AS1 and miR-145 in osteosarcoma tissues (R2 = 0.71, P < 0.01). ZEB2-AS1 knockdown resulted in decreased osteosarcoma cell proliferation, increased apoptosis and reduced migration. In addition, negative regulation of miR-145 by ZEB2-AS1 in osteosarcoma cells was also observed, and the effects of ZEB2-AS1 on osteosarcoma cells were found to be regulated by miR-145. Significantly upregulated lncRNA ZEB2-AS1 expression in osteosarcoma patients influences the prognosis of patients, and ZEB2-AS1 accelerates tumorigenesis and osteosarcoma development by downregulating miR-145.

Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain.

BACKGROUND: Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis. METHODS: This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar visual analog scale (VAS), MacNab score, and postoperative complications were used to evaluate the outcomes. All outcome assessments were performed at postoperative 1 day, 1 month, 3 months, 6 months, and 12 months. RESULTS: There was no difference between the two groups in preoperative VAS (P > 0.05). VAS scores, except the postoperative first day, in all other postoperative time points were significantly lower than preoperative values each in both groups (P < 0.05). There was no significant difference between the two groups in VAS at 1 day, 1 month, and 3 months after surgery (P > 0.05). However, the EFRA demonstrated significant benefits at the time points of 3 months and 6 months (P > 0.05). The MacNab scores of 1-year follow-up in the ERFA group were higher than that in the control group (P < 0.05). The incidence of complications in the ERFA group was significantly less than that in the control group (P < 0.05). CONCLUSIONS: ERFA may achieve more accurate and definite denervation on the nerves, which leads to longer lasting pain relief.

Spine surgeon specialty differences in single-level percutaneous kyphoplasty.

BACKGROUND: Percutaneous kyphoplasty (PKP) is a procedure performed by a spine surgeon who undergoes either orthopedic or neurosurgical training. The relationship between short-term adverse outcomes and spine specialty is presently unknown. To compare short-term adverse outcomes of single-level PKP when performed by neurosurgeons and orthopedic surgeons in order to develop more concretely preventive strategies for patients under consideration for single-level PKP. METHODS: We evaluated patients who underwent single-level PKP from 2012 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). We used univariate analysis and multivariate logistic regression to assess the association between spine surgeon specialty and short-term adverse events, including postoperative complication and unplanned readmission, and to identify different independent risk predictors between two specialties. RESULTS: Of 2248 patients who underwent single-level PKP procedure, 1229 patients (54.7%) had their operations completed by a neurosurgeon. There were no significant differences in the development of the majority of postoperative complications and the occurrence of unplanned readmission between the neurosurgical cohort (NC) and the orthopedic cohort (OC). A difference in the postoperative blood transfusion rate (0.7% NS vs. 1.7% OC, P = 0.039) was noted and may due to the differences in comorbidities between patients. Multivariate regression analysis revealed different independent predictors of postoperative adverse events for the two spine specialties. CONCLUSIONS: By comparing a large range of demographic feature, preoperative comorbidities, and intraoperative factors, we find that short-term adverse events in single-level PKP patients does not affect by spine surgeon specialty, except that the OC had higher postoperative blood transfusion rate. In addition, the different perioperative predictors of postoperative complications and unplanned readmissions were identified between the two specialties. These findings can lead to better evidence-based patient counseling and provide valuable information for medical evaluation and potentially devise methods to reduce patients' risk.

3D-Printed Prosthesis Replacement for Limb Salvage after Radical Resection of an Ameloblastoma in the Tibia with 1 Year of Follow Up: A Case Report.

Ameloblastoma in the tibia is rare. Limb reconstruction after tumor resection is challenging in terms of selection of the operative method. Here, we report a case of radical resection of an ameloblastoma in the mid-distal tibia combined with limb salvage using a three-dimensional (3D)-printed prosthesis replacement, with 1-year follow-up results. After receiving local institutional review board approval, a titanium alloy prosthesis was designed using a computer and manufactured with 3D-printing technology. During the operation, the stem of the prosthesis was inserted closely into the proximal tibial medullary cavity. Then, the metal ankle mortise and the talus were compacted closely. Radiographic results at 1-year follow up showed that the prosthesis was well placed, and no loosening was observed. The Musculoskeletal Tumor Society (MSTS) 93 functional score was 26 points, and the functional recovery percentage was 86.7%. Computer-assisted 3D-printing technology allowed for more volume and structural compatibility of the prosthesis, thereby ensuring a smooth operation and initial prosthetic stabilization. During the follow up, the presence of bone ingrowths on the porous surface of some segments of the prosthesis suggested good outcomes for long-term biological integration between the prosthesis and host bone.

Cervical posterior longitudinal ligament ossification : Microscopy-assisted anterior corpectomy and fusion.

OBJECTIVE: To explore the clinical efficacy and safety of microscopy-assisted anterior corpectomy and fusion for cervical ossification of the posterior longitudinal ligament (OPLL). METHODS: A retrospective review of 32 cervical OPLL patients who underwent microscopy-assisted anterior corpectomy and fusion from June 2012 to March 2017 was carried out. Patients were evaluated with outcome metrics: Japanese Orthopaedic Association (JOA) scores (17 points method), visual analog scale (VAS), and radiographic parameters of the lordotic angle. The complications during treatment and follow-up were recorded. RESULTS: This study included 32 patients (15 males and 17 females) with a mean age of 58.3 ± 2.9 years (range 42-68 years). The average duration of follow-up was 19.0 ± 3.5 months (range 11-46 months). The scores of postoperative VAS significantly decreased (P < 0.05). The average JOA score at 12 months postoperation significantly improved (p < 0.05). The lordotic angle increased after surgery (P < 0.05). There was no titanium mesh subsidence, no pseudarthrosis or hardware failure at 1­year follow-up. COMPLICATIONS: One cerebrospinal fluid leakage in the surgery was managed using a gelatine sponge and the patient recovered after 1 week: One patient developed laryngeal nerve injury symptom of hoarseness and recovered spontaneously in 2 weeks without intervention and 1 patient suffered slight postoperative infection. There was no worsening of neurological function. CONCLUSION: Microscopy-assisted anterior cervical anterior surgery appears to be a safe and effective treatment option for selected cases of cervical posterior longitudinal ligament ossification.

[Application of meshy fascia encapsulating cancellous bone graft in repair of bone defect after limb fractures].

Objective: To investigate the effectiveness of meshy fascia encapsulating cancellous bone graft in repair of bone defect after limb fractures. Methods: A clinical data of 21 cases of traumatic bone defect after limb fractures, who were treated with meshy fascia encapsulating cancellous bone graft between June 2011 and December 2016, was retrospectively analyzed. There were 13 males and 8 females, aged 14-64 years with an average of 40.1 years. The location of bone defect included humerus in 3 cases, radius in 5 cases, ulna in 4 cases, femur in 2 cases, and tibia in 7 cases. AO classification of primary fractures were type A in 2 cases, type B in 7 cases, and type C in 12 cases. There were 14 cases of open fracture, and 7 cases of closed fracture associated with bone defect. The time from injury to bone defect repair was 5-165 days (mean, 21.3 days). The length of bone defect was 2.5-6.5 cm with an average of 4.5 cm. Results: The operation time was 86-130 minutes (mean, 101 minutes). The intraoperative blood loss was 185-647 mL (mean, 316 mL). One case of superficial infection and 2 cases of delayed healing of incision occurred after operation, and no neurovascular injury occurred. All the 21 patients were followed up 12-36 months (mean, 19 months). The clinical healing time was 2.5-7.0 months (mean, 5.4 months); no delayed healing and nonunion occurred, the bony healing rate was 100%. There was no deep infection, infection recurrence, broken of internal fixator, or refracture. At last follow-up, the grading of bony healing were all rated as excellent, and the functional recovery of the affected limb was excellent in 12 cases, good in 7 cases, and fair in 2 cases with an excellent and good rate of 90.5%. Conclusion: Meshy fascia encapsulating cancellous bone graft in repair of bone defect after limb fracture is characterized by easy to harvest fascia, simplicity of operation, no adverse reaction, lower cost, and satisfactory results.

Diagnostic performance of choline PET/CT for the detection of bone metastasis in prostate cancer: A systematic review and meta-analysis.

PURPOSE: The aim of this study was to evaluate the diagnostic performance of choline positron emission tomography/computed tomography (PET/CT) for the detection of bone metastasis in patients with prostate cancer. METHODS: MEDLINE, EMBASE and the Cochrane Library were searched up to 20 February 2018 for studies that used 11C-choline or 18F-choline PET/CT for the detection of bone metastasis in patients with prostate cancer and "histopathology and/or clinical follow-up" as the reference standard. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Pooled diagnostic accuracy with the 95% confidence interval (CI) was calculated using a bivariate random effects model. We also constructed hierarchical summary receiver operating characteristic curves and performed meta-regression analyses. RESULTS: Fourteen studies with reasonable methodological quality were included in the analysis. On a per-patient basis, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.89 (95% CI 0.80-0.94), 0.98 (95% CI 0.95-0.99), 40.4 (95% CI 19.7-82.6), 0.12 (95% CI 0.07-0.20), and 344 (95% CI 148-803), respectively. On a per-lesion basis, the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.91 (95% CI 0.85-0.94), 0.97 (95% CI 0.95-0.98), 34.1 (95% CI 20.0-58.1), 0.10 (95% CI 0.06-0.16), and 358 (95% CI 165-778), respectively. In the meta-regression analysis, the clinical setting (staging vs. restaging) was the only source of study heterogeneity on a per-patient basis. CONCLUSIONS: Choline PET/CT shows excellent diagnostic performance for the detection of bone metastasis. However, a negative choline PET/CT result cannot ensure the lack of bone metastasis.

Comparison of titanium cable tension band and nickel-titanium patella concentrator for patella fractures.

BACKGROUND: Patellar fractures account for approximately 1% of all fractures. Due to the patella's importance as regards the extensor mechanism, effort should be made to preserve the patella. Several operative treatment methods have been introduced for patella fractures. OBJECTIVES: This study aims to compare the clinical effect of a titanium cable tension band and nickeltitanium (NiTi) patella concentrator (NT-PC) in treating patella fractures. MATERIAL AND METHODS: Thirty-nine patients with patella fractures were enrolled in this retrospective study. All the patients were treated via the open reduction internal fixation procedure using a titanium cable tension band or NT-PC. All the patients were followed up over an average period of 13 months. The main outcome measures were operation time, time of fracture union, postoperative complications, and Böstman knee scores. Statistical analyses were conducted between the 2 groups. RESULTS: All the patients were operated on successfully. The operation time of the NT-PC treatment group was less than that of the titanium cable tension band treatment group (p < 0.05). The mean scores at the final follow-up were 28.2 and 27.6 points in the titanium cable tension band and NT-PC groups, respectively. No significant difference was observed between the excellent and good results (p > 0.05). CONCLUSIONS: Both titanium cable tension band and NT-PC showed good efficacy for the treatment of patellar fractures. NT-PC fixation, a new option for the treatment of patella fractures, is a simple and effective fixation method.

MicroRNA-145 Mediates Steroid-Induced Necrosis of the Femoral Head by Targeting the OPG/RANK/RANKL Signaling Pathway.

OBJECTIVE: To investigate the role of microRNA-145 (miR-145) in steroid-induced necrosis of the femoral head (SINFH) by evaluating its effects on the OPG/RANK/RANKL signaling pathway. METHODS: A rat model of SINFH was constructed via injection of the lentiviral vector pLV-shRNA-miR-145. Pathological observation was performed via tartrate-resistant acid phosphatase (TRAP) staining, and serum OPG levels were detected by ELISA. The mRNA expression levels of miR-145, OPG, RANK and RANKL in THP-1 cells were assessed by RT-PCR, and the protein expression levels of OPG, RANK and RANKL were assessed by western blotting. RESULTS: The expression of miR-145 in the lentivirus-mediated miR-145 group was significantly up-regulated compared with that in the control and normal groups (both P < 0.01). Serum OPG levels were decreased in SINFH rats compared with control and normal rats. The mRNA and protein expression levels of OPG in THP-1 cells decreased after transfection (all P < 0.05). By contrast, the mRNA and protein expression levels of RANK and RANKL in THP-1 cells increased after transfection (all P < 0.05). After transfection of 293T cells with an miR-145 overexpression vector, miR-145 expression in 293T cells increased significantly, while OPG mRNA and protein expression decreased significantly (all P < 0.05). CONCLUSION: MiR-145 plays a role in the occurrence of SINFH by targeting the OPG/RANK/RANKL signaling pathway.

[Effectiveness of arthroscopic treatment for lateral discoid meniscus injuries].

OBJECTIVE: To evaluate the surgical technique and effectiveness of arthroscopic treatment for lateral discoid meniscus injury. METHODS: Between January 2010 and May 2011, 38 patients (42 knees) with lateral discoid meniscus injuries underwent arthroscopic treatment. There were 23 males (24 knees) and 15 females (18 knees), aged 7-62 years (median, 32.8 years). The disease duration was 7 days to 40 years (median, 8.6 months). According to Watanabe's classification of discoid meniscus, 22 knees were classified as complete type, 19 knees as incomplete type, and 1 knee as Wrisberg type. Meniscus plasty combined with suture was performed in 25 patients (28 knees), partial meniscectomy in 12 patients (13 knees), and complete meniscectomy in 1 patient (1 knee). After operation, the rehabilitation training programs (including straight-leg-raising exercise and range of motion exercise) were carried out. RESULTS: All incisions healed primarily. The patients basically had normal activities after 3-4 weeks. All the patient were followed up 12-18 months (mean, 14.3 months). No joint locked or clicking symptom occurred; no tear or revision was noted during follow-up. At 3 months, 6 months, and 1 year after operation, the range of flexion and extension were significantly improved when compared with ones at preoperation (P < 0.05). Based on Ikeuchi's grading, the results were excellent in 22 knees, good in 16 knees, and fair in 4 knees with an excellent and good rate of 90.4%. The Lysholm score was significantly increased to 88.57 +/- 2.95 at immediate, 91.02 +/- 4.17 at 3 months, 92.90 +/- 3.36 at 6 months, and 94.74 +/- 3.52 at 12 months after operation from 69.38 +/- 4.59 before operation (P < 0.05). CONCLUSION: Treatment of lateral discoid meniscus injury under arthroscopy has the advantages of minor trauma, precise resection or repair meniscus, preservation of more meniscus function, and low incidence of osteoarthritis. If the operation is combined with standard rehabilitation training, the short-term effectiveness can be enhanced.